Individual
SUSAN R HEINRICHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 972-5055
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 972-5055
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA0002213
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290133100
—
FL
01
—
970004473
RAILROAD MEDICARE
FL
01
—
Y04FP
BC/BS
FL
Enumeration date
06/16/2005
Last updated
11/21/2011
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